Women in the criminal justice system are four-five times as likely to have cervical cancer compared to non- incarcerated women. Some have attributed this disparity to difficulty in follow-up of abnormal Paps, but little is known empirically about why women involved in the criminal justice system have low abnormal Pap follow-up rates. The objective of this application is two-fold: to understand the interpretation of abnormal Pap events and their subsequent follow-up from the perspective of incarcerated women;second, to interpret women's abnormal Pap events and follow-ups based on a review of their medical records. The validation of women's accounts of abnormal Pap follow-up (or lack thereof) with medical chart review will provide an understanding as to why some women do not gain access to follow-up care. Thus, we will be able target interventions to address this documented gap in women's understanding of abnormal Pap events versus actual events. To meet this objective, first we will conduct focus groups and in-depth interviews with 40 women in a Kansas City county jail about abnormal Pap screening and subsequent follow-up events. Studying women's experiences with abnormal Paps and follow-up may provide clues as to their cervical cancer screening knowledge and the processes by which women actually seek out cervical cancer prevention services given their movement in and out of jails. Second, we will ask the 40 women previously interviewed for permission to access their medical records, in order to investigate whether incarcerated women's self-report of abnormal Pap and follow-up events matched actual medical records of these events. This aim will allow us to gauge women's understanding of Pap events, validate the medical barriers that women faced in trying to gain access to follow- up care, and demonstrate the feasibility of assessing health care access through medical chart review for this high-risk population. This project has significance for public health impact by providing insight into how to address the cervical cancer burden for women involved in the criminal justice system. This project is innovative in its goal of assessing incarcerated women's understanding of abnormal Pap events and validating their understanding with medical record review. Study findings will contribute to the development of an intervention that attempts to close the cervical cancer health gap between women involved in the criminal justice system and their sisters in the "free" world. PUBLIC HEALTH RELEVANCE: The public health impact of this study is that it will inform interventions that reduce cervical health morbidity and mortality for an already disadvantaged group, women involved in the criminal justice system. This study will tell us not only about the chasm between women's understanding of Pap events and actual medical encounters, but will also speak more generally to this population's experience with health care access, given their movement in and out of the criminal justice system.